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Chaiyasirinroje B.,TB HIV Research Project | Aung M.N.,Juntendo University | Moolphate S.,TB HIV Research Project | Moolphate S.,Research Institute of Tuberculosis RIT | And 9 more authors.
Infection and Drug Resistance | Year: 2012

Background and setting: Thailand is one of the highest tuberculosis (TB)-burdened countries. Chiang Rai, the northernmost province of Thailand has high tuberculosis and human immunodeficiency virus (HIV) prevalence and the laboratory workload for TB culture and drug susceptibility testing is increasing. Objectives: To evaluate the simply modified microscopic-observation drug-susceptibility assay (MODS) in the setting of a developing country. Methods: In this cross-sectional diagnostic study, a total of 202 sputum samples of clinically diagnosed TB patients were used to test the performance of MODS assay in reference to gold standard BACTEC™ MGIT™ 960 liquid culture system and Ogawa solid culture. Sputum samples were collected from clinically diagnosed TB patients. Culture growth rate and time to culture positivity were compared among three methods. Performance of modified MODS assay was evaluated for detection of mycobacterium drug resistance in reference to MGIT antimicrobial susceptibility test (AST). Result: Median time to culture positivity by MODS, solid, and liquid culture were 12, 30, and 6 days respectively. Compared to the drug susceptibility test (DST) result of reference liquid culture, the sensitivity and specificity of MODS for detection of multidrug-resistant tuberculosis (MDR-TB) was 85.7% and 97.5% respectively. MODS assay has a positive predicative value of 80% and negative predictive value of 96.5% for isoniazid resistance, 70% and 100% for rifampicin resistance, and 66.7% and 99.1% for MDR-TB. Conclusion: MODS is a highly effective screening test for detection of MDR-TB. © 2012 Chaiyasirinroje et al, publisher and licensee Dove Medical Press Ltd.

Floyd S.,London School of Hygiene and Tropical Medicine | Sismanidis C.,World Health Organization | Yamada N.,Research Institute of Tuberculosis RIT | Daniel R.,London School of Hygiene and Tropical Medicine | And 6 more authors.
Emerging Themes in Epidemiology | Year: 2013

Background: An unprecedented number of nationwide tuberculosis (TB) prevalence surveys will be implemented between 2010 and 2015, to better estimate the burden of disease caused by TB and assess whether global targets for TB control set for 2015 are achieved. It is crucial that results are analysed using best-practice methods. Objective. To provide new theoretical and practical guidance on best-practice methods for the analysis of TB prevalence surveys, including analyses at the individual as well as cluster level and correction for biases arising from missing data. Analytic methods. TB prevalence surveys have a cluster sample survey design; typically 50-100 clusters are selected, with 400-1000 eligible individuals in each cluster. The strategy recommended by the World Health Organization (WHO) for diagnosing pulmonary TB in a nationwide survey is symptom and chest X-ray screening, followed by smear microscopy and culture examinations for those with an abnormal X-ray and/or TB symptoms. Three possible methods of analysis are described and explained. Method 1 is restricted to participants, and individuals with missing data on smear and/or culture results are excluded. Method 2 includes all eligible individuals irrespective of participation, through multiple missing value imputation. Method 3 is restricted to participants, with multiple missing value imputation for individuals with missing smear and/or culture results, and inverse probability weighting to represent all eligible individuals. The results for each method are then compared and illustrated using data from the 2007 national TB prevalence survey in the Philippines. Simulation studies are used to investigate the performance of each method. Key findings. A cluster-level analysis, and Methods 1 and 2, gave similar prevalence estimates (660 per 100,000 aged ≥ 10 years old), with a higher estimate using Method 3 (680 per 100,000). Simulation studies for each of 4 plausible scenarios show that Method 3 performs best, with Method 1 systematically underestimating TB prevalence by around 10%. Conclusion: Both cluster-level and individual-level analyses should be conducted, and individual-level analyses should be conducted both with and without multiple missing value imputation. Method 3 is the safest approach to correct the bias introduced by missing data and provides the single best estimate of TB prevalence at the population level. © 2013 Floyd et al.; licensee BioMed Central Ltd.

Izumi K.,Research Institute of Tuberculosis RIT | Izumi K.,Nagasaki University | Kawatsu L.,Research Institute of Tuberculosis RIT | Ohkado A.,Research Institute of Tuberculosis RIT | And 3 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2016

S E TT ING: In Japan, a decline in tuberculosis (TB) notification rates and shortening of duration of hospitalisation have led to a drastic decrease in the number of hospital beds for TB patients (TB beds), causing severe undersupply in certain regions. OBJECT IVE: To assess the current status of spatial access to TB beds in Japan and evaluate the potential impact of health resource reconstruction in mitigating undersupply of TB beds. DESIGN: A cross-sectional study was conducted whereby a two-step floating catchment area (2SFCA) method was used to calculate an 'accessibility score' to evaluate spatial accessibility of TB beds in the regions classified by four levels of urbanisation. The impact of introducing 'potential TB beds' was assessed via the changes in the proportion of undersupplied regions and TB patients notified from undersupplied regions. RESULTS: Undersupplied regions were characterised by 'very low', 'low' and 'moderate' level of urbanisation. By introducing 'potential TB beds', the proportion of both undersupplied regions and TB patients could be significantly reduced, especially in less urbanised regions. CONCLUSION: Our results may be used to guide future decision-making over resource allocation of TB care in Japan. The 2SFCA method may be applied to other countries using appropriate demand and supply variables. © 2016 The Union.

Izumi K.,Research Institute of Tuberculosis RIT | Izumi K.,Nagasaki University | Ohkado A.,Research Institute of Tuberculosis RIT | Ohkado A.,Nagasaki University | And 6 more authors.
PLoS ONE | Year: 2015

Background: Identifying ongoing tuberculosis infection sites is crucial for breaking chains of transmission in tuberculosis-prevalent urban areas. Previous studies have pointed out that detection of local accumulation of tuberculosis patients based on their residential addresses may be limited by a lack of matching between residences and tuberculosis infection sites. This study aimed to identify possible tuberculosis hotspots using TB genotype clustering statuses and a concept of "activity space", a place where patients spend most of their waking hours. We further compared the spatial distribution by different residential statuses and describe urban environmental features of the detected hotspots. Methods: Culture-positive tuberculosis patients notified to Shinjuku city from 2003 to 2011 were enrolled in this case-based cross-sectional study, and their demographic and clinical information, TB genotype clustering statuses, and activity space were collected. Spatial statistics (Global Moran's I and Getis-Ord Gi∗ statistics) identified significant hotspots in 152 census tracts, and urban environmental features and tuberculosis patients' characteristics in these hotspots were assessed. Results: Of the enrolled 643 culture-positive tuberculosis patients, 416 (64.2%) were general inhabitants, 42 (6.5%) were foreign-born people, and 184 were homeless people (28.6%). The percentage of overall genotype clustering was 43.7%. Genotype-clustered general inhabitants and homeless people formed significant hotspots around a major railway station, whereas the non-clustered general inhabitants formed no hotspots. This suggested the detected hotspots of activity spaces may reflect ongoing tuberculosis transmission sites and were characterized by smaller residential floor size and a higher proportion of nonworking households. Conclusions: Activity space-based spatial analysis suggested possible TB transmission sites around the major railway station and it can assist in further comprehension of TB transmission dynamics in an urban setting in Japan. © 2015 Izumi et al.

Mahyiuob Al-Honahi H.Y.,National Tuberculosis Institute NTI | Ohkado A.,Research Institute of Tuberculosis RIT | Masui T.,Mental Health and Welfare Center in Aichi Prefecture | Ali-Hussein I.A.,Coordinator of Primary Health Care | Saeed Al-Absi A.N.,National Tuberculosis Control Programme NTCP
Kekkaku | Year: 2010

[Objectives]: The study aims to show the feasibility of involvement of Non-Governmental Organization (NGO) health volunteers with regular monitoring mechanism on tuberculosis (TB) control in Sanaa City, Yemen. [Methods]: Interventions to mobilize NGO health volunteers with regular monitoring field visits in two selected districts with approximately 400,000 population in Sanaa City were conducted. 52 NGO health volunteers who belonged to a domestic NGO were trained on TB case finding and case holding activities by the national TB control programme staff during the fourth quarter of 2004. [Results]: 136 new smear-positive TB cases were enrolled from January 2005 to September 2006. The cure rates indicated significant improvement from 73.4% to 84.6% after start of the intervention (p = 0.023). The cure rate of patients whose treatment partners were health volunteers was significantly higher than patients whose treatment partners were health centre staff (93.3% vs. 79.8%, Exact p = 0.045). [Conclusion]: The present study showed the favourable results of the implementation of the intervention in two selected districts in Sanaa City with regards to the treatment outcomes. The National Tuberculosis Control Programme has decided to expand the NGO's health volunteers' involvement as treatment partners to at least urban settings in Yemen.

Yoshimatsu S.,University of Tsukuba | Yoshimatsu S.,Research Institute of Tuberculosis RIT | Sugaya T.,CMIC | Hossain M.I.,Center for Nutrition and Food Security | And 7 more authors.
Pediatrics International | Year: 2016

Background Although sepsis is often associated with high mortality in severely malnourished children, data are very limited on appropriate diagnostic tools to predict mortality. We examined the role of urinary liver-type fatty acid-binding protein (L-FABP) in children <5 years old with sepsis who died. Methods This prospective observational study was conducted at the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. Children aged 6-59 months admitted with sepsis from April 2010 to December 2011 were enrolled. Comparison of clinical and laboratory characteristics was made between children who survived (n = 83) and those who did not survive (n = 22). Results On multiple Poisson regression analysis, after adjusting for potential confounders such as mid-upper arm circumference < 115 mm, plasma albumin < 2.5 g/dL, potassium > 5.0 mmol/L, and blood urea nitrogen > 20 mg/dL on admission, first urine L-FABP ≥ 370 ng/mL (relative risk [RR], 2.76; 95%CI: 1.22-6.25), weight-for-length/height z score < -3 (RR, 2.54; 95%CI: 1.26-5.09), capillary refilling time > 2.0 s (RR, 5.16; 95%CI: 1.46-18.3), and sodium > 160 mmol/L (RR, 2.72; 95%CI: 1.07-6.90) were identified as significant risk factors of mortality in children with sepsis. Diagnostic performance of first urine L-FABP was analyzed using receiver operating characteristic curve, and the area under the curve was 0.647 (95%CI: 0.500-0.795). Conclusion Urinary L-FABP may be a useful predictor of mortality in septic children. Urinary examination is non-invasive and easy to apply at the bedside. © 2015 Japan Pediatric Society.

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